A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative...

Area of Science:

• Spinal Surgery
• Medical Technology
• Surgical Navigation

Background:

• Comparing image guidance systems for pedicle screw placement (PSP) is crucial for optimizing accuracy and safety.
• Systems evaluated include conventional, navigation, robot-assisted, and augmented reality (AR) guiding technologies.

Purpose of the Study:

• To conduct a network meta-analysis comparing the accuracy and safety of various image guidance systems for pedicle screw placement.
• To rank these systems based on accuracy, safety, and clinical outcomes using Surface Under the Cumulative Ranking Curve (SUCRA).

Main Methods:

• A network meta-analysis of human comparative studies and randomized controlled trials (RCTs) sourced from Cochrane, PubMed, and Scopus.
• Extracted data on accuracy, safety, and clinical outcomes for 17,023 patients and 35,451 pedicle screws across 61 studies.
• Utilized SUCRA to rank the efficacy of different pedicle screw placement guidance systems.

Main Results:

• Robot-assisted technology demonstrated superior accuracy in most outcomes, excluding facet joint violations.
• Augmented reality (AR) showed significantly higher accuracy for perfect placement (Risk Difference: 19.1) compared to conventional methods.
• Robot-assisted and navigation systems offered improved outcomes, though not significantly different in accuracy from the conventional technique. No significant differences in safety or clinical outcomes were observed.

Conclusions:

• Robot-assisted technology provides the highest accuracy for pedicle screw placement.
• Augmented reality (AR) guidance systems offer enhanced accuracy compared to navigation and conventional methods.
• Safety and clinical outcomes were comparable across all evaluated image guidance systems for pedicle screw placement.